Myocarditis (Carditis)

Inflammatory processes of the muscular walls of the heart (MYOCARDIUM) which result in injury to the cardiac muscle cells (MYOCYTES, CARDIAC). Manifestations range from subclinical to sudden death (DEATH, SUDDEN). Myocarditis in association with cardiac dysfunction is classified as inflammatory CARDIOMYOPATHY usually caused by INFECTION, autoimmune diseases, or responses to toxic substances. Myocarditis is also a common cause of DILATED CARDIOMYOPATHY and other cardiomyopathies.

Also Known As:

Networked: 8113 relevant articles (516 outcomes, 913 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Inflammation (Inflammations)
2.	Heart Failure
3.	Dilated Cardiomyopathy (Cardiomyopathy, Congestive)
4.	Cardiomyopathies (Cardiomyopathy)
5.	Infections

Experts

1.	Klingel, Karin: 78 articles (01/2022 - 05/2003)
2.	Kodama, Makoto: 57 articles (04/2013 - 01/2002)
3.	Aizawa, Yoshifusa: 43 articles (03/2011 - 01/2002)
4.	Watanabe, Kenichi: 42 articles (01/2018 - 01/2002)
5.	Cooper, Leslie T: 40 articles (10/2022 - 04/2002)
6.	Schultheiss, Heinz-Peter: 40 articles (01/2022 - 06/2002)
7.	Kishimoto, Chiharu: 38 articles (03/2015 - 07/2002)
8.	Tschöpe, Carsten: 35 articles (01/2022 - 05/2004)
9.	Kandolf, Reinhard: 33 articles (03/2017 - 01/2003)
10.	Rose, Noel R: 32 articles (01/2017 - 02/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Myocarditis:

1.	Intravenous Immunoglobulins (IVIG)FDA Link 01/01/2020 - "The evidence was also uncertain for improvement in LVEDD and LVSF after six months (LVEDD MD -4.00, 95% CI -9.52 to 1.52; LVSF no raw data).  Evidence for improvement in LVEF, functional capacity, side effects, complete recovery, and hospitalisation status in children was not reported.  AUTHORS' CONCLUSIONS: Evidence from two trials of very low certainty and with unclear risk of bias provides contradictory evidence on the use of IVIG in the treatment of adults with presumed viral myocarditis. " 12/01/2012 - "Use of IVIG seemed to have a beneficial effect in terms of improved clinical outcomes in children with AES complicated by myocarditis. " 02/01/2002 - "The rapid recovery, which was immediately subsequent to the administration of high-dose IVIG, suggests that this kind of treatment has been effective in our patient with acute myocarditis." 01/01/1994 - "These data suggest that use of high-dose IVIG for treatment of acute myocarditis is associated with improved recovery of left ventricular function and with a tendency to better survival during the first year after presentation." 03/20/2019 - "The aim of this study was to conduct a meta-analysis to assess the efficacy of IVIG in children and adults with acute myocarditis.We"
2.	CytokinesIBA 05/01/2010 - "The cured animals showed an absence of myocarditis and a normalisation of cytokine production in the sera. " 09/01/2001 - "Expression of immunoregulatory cytokines by recombinant coxsackievirus B3 variants confers protection against virus-caused myocarditis." 01/01/2018 - "This study evaluates and correlates the number of myocarditis focuses and production of cytokines in Rattus norvegicus (Wistar lineage), experimentally infected with T. " 01/01/2017 - "The current study established an association between CXCR5/CXCL13, autoimmune myocarditis and pro-inflammatory cytokines, and provided sound basis for further studies on mechanism and treatment of autoimmune myocarditis." 03/01/2008 - "The purpose of this study was to assess myocardial CAR expression in response to cytokine-induced inflammatory reactions during the course of coxsackievirus-induced myocarditis. "
3.	Adrenal Cortex Hormones (Corticosteroids)IBA 01/01/2017 - "Low-dose corticosteroid may be effective in selected patients with eosinophilic myocarditis. " 09/03/2015 - "However, immediate systemic corticosteroids are known to be effective against eosinophilic myocarditis; therefore, prompt diagnosis of this disease is crucial. " 04/01/1999 - "The role of corticosteroids in treatment of carditis is uncertain and controlled studies have failed to demonstrate improved long term prognosis. " 03/13/2023 - "To evaluate the efficacy of corticosteroids in anti-inflammatory treatment of pediatric acute myocarditis. " 01/01/2023 - "While corticosteroids are often used for specific forms of myocarditis (eg, eosinophilic or giant cell infiltrations), this practice is based on anecdotal evidence, and randomized clinical trials of optimal therapeutic interventions for acute myocarditis are needed."
4.	SteroidsIBA 09/01/2019 - "A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. " 10/01/2014 - "Steroids alone were effective in 50% of patients with myocarditis. " 08/01/2020 - "One patient died shortly after myocarditis diagnosis, one was made comfort care due to poor clinical status, and one improved with steroid treatment." 09/01/2009 - "Here, we present a case of AOSD associated with myocarditis, in which the patient responded well to systemic steroids." 07/01/2006 - "ARF with carditis benefited from steroids with partial to total regression in 41/45 patients (91%), two patients underwent valve repair or replacement, another patient died from severe pancarditis. "
5.	VaccinesIBA 01/01/2014 - "Compared with chitosan-pVP1 vaccine immunization alone, chitosan-pAIM2 co-immunization enhanced resistance to CVB3-induced myocarditis evidenced by significantly enhanced ejection fractions from 55.40 ± 9.35 to 80.31 ± 11.35, improved myocarditis scores from 1.50 ± 0.45 to 0.30 ± 0.15, reduced viral load from 3.33 ± 0.50 to 0.50 ± 0.65, and increased survival rate from 40.0% to 75.5%. " 01/01/2022 - "The case of vaccine-associated myocarditis highlights the need to incorporate precision vaccinology approaches for the development of safe and effective vaccines for everyone." 01/01/2017 - "Our results indicate that AIM2-adjuvanted vaccine could be a potential and promising approach to promote a long-lasting protection against CVB3-induced myocarditis." 10/01/2023 - "Several studies have reported side effects of the Pfizer vaccine, including rare conditions such as myocarditis. " 01/01/2023 - "Anti-SARS-CoV-2 vaccine-induced myocarditis - real but, in general, rare and mild: A consensus statement from the Studies Committee of the Portuguese Society of Cardiology."
6.	Clozapine (Clozaril)FDA LinkGeneric 10/01/2007 - "This combination approach helped in the early recognition and successful treatment of clozapine myocarditis in one of our patients. " 11/01/2023 - "The gold-standard for diagnosing myocarditis is an endomyocardial biopsy but there are no clear recommendations for how to use less invasive screening assessments to monitor for CIM during a clozapine rechallenge. " 01/01/2023 - "Safety and Efficacy of Electroconvulsive Therapy in Clozapine-Induced Myocarditis." 11/01/2021 - "Subsequent CT chest, however, ruled out any pericardial pathology and eliminated suspicion for clozapine-induced myocarditis. " 08/01/2021 - "A pharmacist-driven myocarditis monitoring protocol for clozapine-naïve patients may help to identify early signs of clozapine-induced myocarditis and therefore mitigate potentially life-threatening complications by prompting early discontinuation of the inciting drug."
7.	Antiviral Agents (Antivirals)IBA 05/01/2001 - "In our murine model, we have investigated the therapeutic efficacy of antiviral drug administration on myocarditis. " 03/01/2015 - "The antiviral and myocyte protective effects of IL-28A in CVB3-induced myocarditis are regulated by STAT1 and STAT2." 03/01/2015 - "Antiviral and myocyte protective effects of IL-28A in coxsackievirus B3-induced myocarditis." 05/14/2010 - "FLC have antiviral and antiinflammatory effects and improved viral myocarditis in mice. " 08/28/2019 - "Our study indicates that SBE is a promising potent antiviral agent against CVB3-induced myocarditis by inhibition of virus replication via depressing AKT and p38 expressions."
8.	Tumor Necrosis Factor-alpha (Tumor Necrosis Factor)IBA 10/01/2008 - "These results show for the first time that DMF ameliorates experimental autoimmune myocarditis and may be acted, at least in part, by interfering with the production of TNF-alpha." 06/01/2008 - "Also, anti-TNF-alpha treatment reduced the frequency of CD8+CCR5+ circulating cells and myocarditis, though parasite load was unaltered in infected C3H/HeJ mice. " 02/06/2001 - "Injection of recombinant human TNF-alpha (0.2 to 4.0 microg/mouse IV) improved the survival of TNF-alpha(-/-) mice in a dose-dependent manner, indicating that TNF-alpha is essential for protection against viral myocarditis. " 04/01/1995 - "In our animal model of EMC virus myocarditis, plasma tumor necrosis factor (TNF)-alpha was elevated in the acute stage and exogenously administered anti TNF-alpha antibody improved the survival and myocardial lesion, suggesting the importance of TNF-alpha in the pathogenesis." 03/01/2008 - "The aim of the present study was to investigate the presence of different viruses and the expression of TNFalpha in children with clinical suspicion of myocarditis. "
9.	Messenger RNA (mRNA)IBA 10/26/2023 - "Further studies are required to investigate the incidence of SARS-CoV-2 mRNA vaccination-associated myocarditis in adolescents and the related mechanisms." 12/01/2022 - "In this small single-centre study, compared to myocarditis referrals in the pre-COVID era, patients currently referred for CMR work-up of suspected mRNA-vaccination-associated myocarditis demonstrated lower prevalence of LGE but higher prevalence of abnormal T1/T2 mapping. " 08/03/2022 - "Eligible studies reported patients older than 18 years vaccinated with mRNA, a diagnosis of myocarditis, and subsequent outcomes. " 01/01/2022 - "The aim of this study was to assess the possible occurrence of peri-/myocarditis in healthy volunteers and to analyze subclinical changes in functional and/or structural cardiac parameters following a mRNA-based booster-vaccination. " 06/28/2002 - "Our previous studies, using differential mRNA display, suggested that the mouse Nip21 gene may be involved in myocarditis development in the coxsackievirus B3 (CVB3)-infected mouse heart. "
10.	Biomarkers (Surrogate Marker)IBA 12/01/2022 - "We sought to determine whether routinely measured biomarkers could be helpful in monitoring for ICI myocarditis. " 07/16/2022 - "The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. " 08/18/2020 - "Abnormal ECG findings and elevations of biomarkers associated with myocarditis showed improvement on the next day. " 01/01/2020 - "This treatment brought immediate benefit: serial echocardiography showed progressive resolution of myocarditis, VA-ECMO was gradually decreased and definitively weaned off in 6 days and MAS laboratory markers improved. " 09/01/2022 - "Additionally, we summarize the mechanism, risk factors, biomarkers, and clinical data from currently published guidelines and studies about ICI-related myocarditis. "

Therapies and Procedures

1.	Therapeutics 06/01/2016 - "Background therapy of myocarditis improved the antiarrhythmic efficiency, and allowed the best premed for interventional treatment." 05/01/2020 - "While they achieved complete response, the occurrence of myocarditis as a toxicity of ICIs may have been a predictive sign that the immune system was sufficiently activated by the checkpoint inhibitor therapy to induce complete remission." 08/01/2016 - "Immunosuppressive treatment might be beneficial for improving left ventricular systolic function and remodeling in patients with myocarditis, which could be considered as a therapeutic alternative when optimal conventional therapy is not effective. " 10/01/2005 - "However, translating these results into recommended, routine therapy for pediatric myocarditis is complicated by the high rate of spontaneous improvement of myocarditis with supportive care, and the lack of demonstrable benefit for immunosuppressive and immunomodulating therapies in blinded, randomized, placebo-controlled trials in adult myocarditis. " 07/01/2013 - "Fulminant myocarditis should be treated with full supportive care, using aggressive pharmacologic therapy and mechanical circulatory support, because significant improvement in left ventricular function will often occur. "
2.	Heart Transplantation (Grafting, Heart) 03/01/1991 - "The likelihood of an adverse event, either cardiovascular mortality or cardiac transplantation, was significantly greater for patients with giant cell myocarditis than for those with lymphocytic myocarditis, perhaps because of the progressive decline in left ventricular systolic function that was observed in those with giant cell myocarditis." 08/01/1988 - "Successful management of acute myocarditis with biventricular assist devices and cardiac transplantation." 02/01/2013 - "We have undertaken this study to establish the criteria for determining the need for heart transplantation following VAD implant for fulminant myocarditis. " 10/15/2007 - "Moreover, recent studies have highlighted the immunosuppressive effect of HGF in animal models of allogenic heart transplantation and autoimmune myocarditis and in studies in vitro as well. " 02/01/2001 - "An earlier study of murine chronic ongoing myocarditis reported that infiltrating T cells and macrophages were prominent in the normal donor heart, in a heterotopic cardiac transplantation model. "
3.	Immunotherapy 01/01/2021 - "We also discuss the adverse events associated with PD-1/L1/2 inhibitors, ranging from severe life-threatening conditions such as autoimmune myocarditis to mild and moderate reactions such as skin rashes, and explore the potential strategies for improving the efficacy of immunotherapy with PD-1/L1 checkpoint inhibitors." 03/01/2013 - "Treatment of acute myocarditis is still mainly supportive, except for giant cell myocarditis where immunotherapy has been shown to improve survival. " 09/01/2023 - "This study comprehensively evaluated the prognostic value of patients' clinical characteristics and examination results and identified several predictors of severe ICI-associated myocarditis, which will facilitate early detection of severe ICI-associated myocarditis in patients receiving immunotherapy." 01/01/2023 - "Although myocarditis currently imposes immunotherapy discontinuation, case reports have suggested a safety rechallenge in low-grade myocarditis paving the way for further studies to respond to this unmet clinical need." 10/15/2021 - "This study emphasized the importance of a high index of suspicion, prompt diagnosis, and early intervention in patients who present with cardiac abnormalities and possible myocarditis after receiving immunotherapy."
4.	Extracorporeal Membrane Oxygenation 05/01/2015 - "Extracorporeal membrane oxygenation can be used effectively in adults with myocarditis to support the circulation while awaiting myocardial recovery. " 01/01/2016 - "Extracorporeal life support can be a first-line treatment in children with acute fulminant myocarditis." 01/01/2022 - "Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of Hemodynamically Unstable Lupus Myocarditis: A Retrospective Case Series Study." 12/01/2018 - "Our study aimed to summarize the clinical outcomes of extracorporeal membrane oxygenation (ECMO) in adult patients with acute fulminant myocarditis and to investigate the risk factors associated with its application. " 01/01/2017 - "This study analyzed the clinical spectrum of acute myocarditis in children to identify factors that could aid primary care physicians to predict the need for extracorporeal membrane oxygenation (ECMO) earlier and consult the pediatric cardiologist promptly. "
5.	Heart-Assist Devices 01/01/2020 - "Described herein are 3 adults in whom histologic study of the left ventricular myocardium excised ("LV core") to insert a left ventricular assist device (LVAD) disclosed severe acute myocarditis and the inflammatory cells included numerous eosinophils (eosinophilic myocarditis). " 02/01/2003 - "Further study is required to assess the role of ventricular assist devices in combination with immunosuppressive therapy in the management of fulminant myocarditis." 11/23/2023 - "We investigated clinical outcomes of combined use of VA-ECMO and percutaneous left ventricular assist device (VAD) (Impella) for fulminant myocarditis in 104 consecutive patients enrolled in the Japan Registry for Percutaneous VAD (J-pVAD) between October 2017 and January 2020. " 09/01/2023 - "Here, we present a 42-year-old female with profound biventricular failure due to fulminant myocarditis, resolved by an isolated durable left-ventricular assist device support under a fenestrated, Fontan-like circulation and managed low-pulmonary vascular resistance." 09/01/2023 - "Fenestrated Fontan-like circulation under durable left-ventricular assist device support in fulminant myocarditis."